THRIVE Study: Understanding How Oral Nicotine Pouches Affect Public Health (THRIVE)

THRIVE Study: Informing Oral Nicotine Pouch Regulations to Promote Public Health

Although nicotine pouches have been gaining popularity over the last few years, little known about how nicotine pouch users actually use these products.

This study will be comprised of adults who use nicotine pouches. If eligible, participants will be asked to complete three study visits and participate in two switching periods where participants use study-provided nicotine pouches.

Study Overview

• Status: Not yet recruiting
• Conditions: Tobacco-Related Carcinoma
• Intervention / Treatment: Procedure: Biospecimen Collection; Other: Survey Administration; Other: Text Message-Based Navigation Intervention; Drug: Nicotine Oral Pouch; Drug: Nicotine Oral Pouch

Detailed Description

This investigation expands on the parent study's Aims 1 and 2 by examining the effects of a feature that the investigators have identified varies across nicotine pouches (ONP): particle size. The investigators expect that particle size differences may translate to differences in user experience. The investigators wish to further explore this hypothesis among current ONP users. Data will be captured over the course of 3 clinic visits and across two week-long switching periods with daily diary surveys. This will inform interpretation of results from Aims 1 and 2, including how to translate those findings to commercially-available nicotine pouches.

Aim 1: Assess the effects of nicotine concentration, form, and isomer on the satisfaction and appeal of ONPs relative to cigarettes and ST. ONPs with high FBN and >99% S-nicotine will have (H1a) increased satisfaction and appeal (e.g., faster nicotine delivery, greater liking). H1b: Associations of form and isomer with addiction potential and appeal will be strongest in the high nicotine concentration arm.

Aim 2: Evaluate the effects of nicotine concentration, form, and isomer on switching from cigarettes or ST to ONPs. Over 4 weeks, participants randomized to use ONPs with high FBN and >99% S-nicotine (vs. other ONPs) will report higher prevalence of (H2a) partially switching to ONPs (use ONPs >14 days but continued usual product use) and (H2b) complete switching to ONPs by week 4. H2c: Associations of form and isomer with switching outcomes will be strongest in the high nicotine concentration arm.

Study Procedures:

Participants will complete three in-person visits. Visits involve randomized, double-blinded use of either small-particle ONPs or a distribution of particle-size ONPs (one assigned product per visit).

Visit 1

• 12-hour abstinence requirement prior to visit.
• Informed consent procedures.
• Baseline questionnaires.
• Exhaled carbon monoxide (CO) testing and pregnancy screening (if applicable).
• IV-line placement followed by four timed blood draws to assess plasma nicotine levels.
• 120-minute controlled ONP use session.

Post-use surveys assessing:

• Product appeal
• Withdrawal symptoms and relief
• Sensory scales
• Behavioral intentions

One-Week Switching Period (at-home)

Following Visit 1, participants enter a 7-day ad libitum use period using their assigned ONPs.

During this phase, participants complete online daily diary surveys (1 per day) to capture product use and switching behavior.

Visit 2

• 12-hour abstinence prior to visit.
• Exhaled CO testing and pregnancy screening (if applicable).
• IV-line placement and four timed blood draws (plasma nicotine levels).
• 120-minute controlled ONP use session.
• Post-use surveys (same as Visit 1).

One-Week Switching Period (at-home)

Following Visit 2, participants enter a 7-day ad libitum use period using their assigned ONPs.

During this phase, participants complete online daily diary surveys (1 per day) to capture product use and switching behavior.

Visit 3

• Completion of survey measures only (no product administration or IV-lines).
• Return of unused ONPs from the at-home switching period.

• Study Type: Interventional
• Enrollment (Estimated): 15
• Phase: Phase 4

Contacts and Locations

• Study Contact: Name: The Ohio State University Comprehensive Cancer Center; Phone Number: 800-293-5066; Email: OSUCCCClinicaltrials@osumc.edu

Study Locations

• United States
  • Ohio
    • Columbus, Ohio, United States, 43210
      • Ohio State University Comprehensive Cancer Center
      • Principal Investigator: Brittney L. Keller-Hamilton, PhD, MPH

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: Adult; Older Adult
• Accepts Healthy Volunteers: Yes

Description

Inclusion Criteria:

• Age 21 or older
• Able to read and speak English
• Willing to abstain from tobacco, nicotine, and marijuana for at least 12 hours prior to study visits
• Exclusive use of ONPs (other product use <10x/mo).
• Exhaled CO reading <10 ppm
• Owns a smartphone and can receive SMS text messages with embedded survey links
• Negative pregnancy test at V1 and V2 (if applicable)
• Uses ≥1.5 cans of ONPs/week
• Daily use of ONPs for the past 3 months
• At least half of ONPs used are 6mg nicotine concentration.

Exclusion Criteria:

• Non-English speaker
• Individuals currently pregnant, planning to become pregnant, or breastfeeding are excluded due to potential risks associated with nicotine exposure and study procedures (e.g., blood draws).
• Individuals with unstable or significant psychiatric conditions are excluded to minimize risk and ensure reliable participation.
• Individuals actively attempting to quit nicotine use are excluded to avoid ethical concerns and ensure that study participation does not interfere with cessation efforts
• Non-nicotine users and regular tobacco users are excluded from the clinical trial component to ensure that participants have established use patterns appropriate for assessing ONP use behaviors.

Study Plan

How is the study designed?

Design Details

• Primary Purpose: Prevention
• Allocation: Randomized
• Interventional Model: Parallel Assignment
• Masking: Double

Number of Arms

2

Arms and Interventions

Participant Group / Arm	Intervention / Treatment
Experimental: Small particle size oral nicotine pouches; CLINIC VISIT: Participants sample a small particle size ONP product. Patients also undergo blood sample collection throughout study. SWITCHING PERIOD: Participants complete a 1-week ad libitum switching period using assigned ONPs. Daily diary surveys are completed remotely to track product use and switching behavior.	Procedure: Biospecimen Collection; Undergo blood sample collection; Other Names: Biological Sample Collection; Other: Survey Administration; Ancillary studies; Other: Text Message-Based Navigation Intervention; Receive text with a link to daily diary surveys; Other Names: Automated Text Message-Based Navigation; Drug: Nicotine Oral Pouch; Insert small particle size ONP; Drug: Nicotine Oral Pouch; Insert variable particle size ONP
Experimental: Variable particle size oral nicotine pouches; CLINIC VISIT: Participants sample a variable particle size ONP product. Patients also undergo blood sample collection throughout study. SWITCHING PERIOD: Participants complete a 1-week ad libitum switching period using assigned ONPs. Daily diary surveys are completed remotely to track product use and switching behavior.	Procedure: Biospecimen Collection; Undergo blood sample collection; Other Names: Biological Sample Collection; Other: Survey Administration; Ancillary studies; Other: Text Message-Based Navigation Intervention; Receive text with a link to daily diary surveys; Other Names: Automated Text Message-Based Navigation; Drug: Nicotine Oral Pouch; Insert small particle size ONP; Drug: Nicotine Oral Pouch; Insert variable particle size ONP

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Nicotine Delivery, Cmax	Nicotine delivery will be summarized by Cmax, the maximum nicotine concentration observed in the plasma samples for each participant.	2 weeks

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Switching Behavior	Switching behavior will be quantified using the number of days during the switching week that each participant completely switches from their usual ONP to the study product.	2 weeks
Nicotine Delivery, Tmax	The time at which the maximum nicotine concentration is observed in the plasma samples for each participant.	2 weeks
Nicotine Delivery, AUC	Area under the curve (AUC) of plasma nicotine levels versus time for each participant.	2 weeks
Craving Relief, QSU	Urges/craving will be measured using a modified version of the Tiffany-Drobes Questionnaire of Smoking Urges: Brief Form (QSU). This is a 10-item measure where participants rate items on a 7-point Likert scale ranging from 1 (strongly disagree) to 7 (strongly agree). Similar to previous studies, the investigators will collapse the items into two previously identified factors (Factor 1: strong desire and intention to use; Factor 2: anticipation of relief from withdrawal symptoms). Scores are calculated by summing the items and range from 5 to 35 for each of the factors with higher scores indicating greater craving.	2 weeks
Withdrawal, MNWS	The Minnesota Nicotine Withdrawal Scale (MNWS) will asses nicotine withdrawal and craving, anger/irritability, anxiety, depressed mood, restlessness/difficulty concentrating, increased appetite, sleep problems, and somatic symptoms (nausea, constipation, sore throat, dizziness, coughing). Scores range from 0 to 4 with higher scores indicating greater levels of withdrawal.	2 weeks
Product Appeal, mCEQ	12-item modified Cigarette Evaluation Questionnaire (mCEQ) completed following e-cigarette self-administration to assess subjective responses to the ONPs. The 12-item mCEQ includes five subscales: Satisfaction, Psychological Reward, Aversion, Enjoyment of Respiratory Tract Sensations, and Craving Reduction, with items rated from 1 (not at all) to 7 (extremely likely). Scores for each subscale are calculated as the mean of the individual item responses or the single item. Higher scores indicate greater intensity on that scale.	2 weeks
Intensity of Sensory Attributes, gLMS	5-item self-report measure completed following ONP administration, using the general Labeled Magnitude Scale (gLMS). Scores range from 0 (no sensation) to 100 (strongest imaginable) with higher scores indicating a greater sensation intensity.	2 weeks

Collaborators and Investigators

• Sponsor: Ohio State University Comprehensive Cancer Center
• Investigators: Principal Investigator: Brittney L. Keller-Hamilton, PhD, MPH, Ohio State University Comprehensive Cancer Center

Publications and helpful links

Helpful Links

• The Jamesline

Study record dates

Study Major Dates

• Study Start (Estimated): July 1, 2026
• Primary Completion (Estimated): December 31, 2027
• Study Completion (Estimated): December 31, 2027

Study Registration Dates

• First Submitted: March 17, 2026
• First Submitted That Met QC Criteria: March 26, 2026
• First Posted (Actual): March 31, 2026

Study Record Updates

• Last Update Posted (Actual): May 26, 2026
• Last Update Submitted That Met QC Criteria: May 21, 2026
• Last Verified: May 1, 2026

More Information

Terms related to this study

• Keywords: Tobacco; Particle Size; Oral Nicotine Pouches; Tobacco Regulation
• Other Study ID Numbers: OSU-26043

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: Yes
• Studies a U.S. FDA-regulated device product: No
• product manufactured in and exported from the U.S.: No